Journal of General Internal Medicine

, Volume 24, Issue 1, pp 63–68 | Cite as

Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing

  • Heather C. O’DonnellEmail author
  • Rainu Kaushal
  • Yolanda Barrón
  • Mark A. Callahan
  • Ronald D. Adelman
  • Eugenia L. Siegler
Original Article



The ability to copy and paste text within computerized physician documentation facilitates electronic note writing, but may affect the quality of physician notes and patient care. Little is known about physicians’ collective experience with the copy and paste function (CPF).


To determine physicians’ CPF use, perceptions of its impact on notes and patient care, and opinions regarding its future use.


Cross-sectional survey.


Resident and faculty physicians within two affiliated academic medical centers currently using a computerized documentation system.


Responses on a self-administered survey.


A total of 315 (70%) of 451 eligible physicians responded to the survey. Of the 253 (80%) physicians who wrote inpatient notes electronically, 226 (90%) used CPF, and 177 (70%) used it almost always or most of the time when writing daily progress notes. While noting that inconsistencies (71%) and outdated information (71%) were more common in notes containing copy and pasted text, few physicians felt that CPF had a negative impact on patient documentation (19%) or led to mistakes in patient care (24%). The majority of physicians (80%) wanted to continue to use CPF.


Although recognizing deficits in notes written using CPF, the majority of physicians used CPF to write notes and did not perceive an overall negative impact on physician documentation or patient care. Further studies of the effects of electronic note writing on the quality and safety of patient care are required.


medical records system, computerized documentation/mt [methods] attitude of health personnel medical staff, hospital user-computer interface 



The authors would like to thank Drs. Erika Abramson, Susan Bostwick, Joseph Cooke, and Charles Schleien. Dr. O’Donnell was funded through the Department of Public Health at Weill Cornell Medical College as a Fellow in Outcomes and Effectiveness Research. The authors of this study have no financial conflicts of interest to disclose.

This study was funded by Weill Cornell Medical College through support for Dr. O’Donnell as part of her fellowship in the Department of Public Health. There was no external funding for this study.

Supplementary material

11606_2008_843_MOESM1_ESM.doc (108 kb)
ESM 1 (DOC 108 KB)


  1. 1.
    Walton RT, Harvey E, Dovey S, Freemantle N. Computerised advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev. 2001;CD002894.Google Scholar
  2. 2.
    Kohn LCJ, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Committee on Quality in America. Washington, DC: Institute of Medicine, National Academy Pr: 1999.Google Scholar
  3. 3.
    Embi PJ, Yackel TR, Logan JR, Bowen JL, Cooney TG, Gorman PN. Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians. J Am Med Inform Assoc. 2004;11:300–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hammond KW, Helbig ST, Benson CC, Brathwaite-Sketoe BM. Are electronic medical records trustworthy? Observations on copying, pasting and duplication. AMIA Annu Symp Proc. 2003;269–73.Google Scholar
  5. 5.
    Thielke S, Hammond K, Helbig S. Copying and pasting of examinations within the electronic medical record. Int J Med Inform. 2007;76(Suppl 1):122–8.CrossRefGoogle Scholar
  6. 6.
    Weir CR, Hurdle JF, Felgar MA, Hoffman JM, Roth B, Nebeker JR. Direct text entry in electronic progress notes. An evaluation of input errors. Methods Inf Med. 2003;42:61–7.PubMedGoogle Scholar
  7. 7.
    Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11:104–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc. 2004;11:100–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Han YY, Carcillo JA, Venkataraman ST. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Zhan C, Hicks RW, Blanchette CM, Keyes MA, Cousins DD. Potential benefits and problems with computerized prescriber order entry: analysis of a voluntary medication error-reporting database. Am J Health Syst Pharm. 2006;63:353–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Koppel R, Metlay JP, Cohen A. Role of computerized physician order entry systems in facilitating medication errors. Jama. 2005;293:1197–203.PubMedCrossRefGoogle Scholar
  12. 12.
    Hartzband P, Groopman J. Off the record-avoiding the pitfalls of going electronic. N Engl J Med. 2008;358:1656–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Hirschtick RE. A piece of my mind. Copy-and-paste. JAMA. 2006;295:2335–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Yackel TR, Embi PJ. Copy-and-paste-and-paste. JAMA. 2006;296:2315. author reply -6.PubMedCrossRefGoogle Scholar
  15. 15.
    Leape LL. Reporting of adverse events. N Engl J Med. 2002;347:1633–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Reed DA, Levine RB, Miller RG. Effect of residency duty-hour limits: views of key clinical faculty. Arch Intern Med. 2007;167:1487–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Okie S. An elusive balance-residents’ work hours and the continuity of care. N Engl J Med. 2007;356:2665–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Kozak LJ, DeFrances CJ, Hall MJ. National Hospital Discharge Survey: 2004 annual summary with detailed diagnosis and procedure data: National Center for Health Statistics: 2006.Google Scholar
  20. 20.
    Levit K, Ryan K, Elixhauser A, Stranges E, Kassed C, Coffey R. HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2005. Rockville, MD: Agency for Healthcare Research and Quality; 2007.Google Scholar
  21. 21.
    Arora V, Kao J, Lovinger D, Seiden SC, Meltzer D. Medication discrepancies in resident sign-outs and their potential to harm. J Gen Intern Med. 2007;22:1751–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Merill CT, Elixhauser A. Hospitalization in the United States, 2002. Rockville, MD: Agency for Heathcare Research and Quality; 2005.Google Scholar
  23. 23.
    Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006;166:1173–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Connolly C. Cedars-Sinai doctors cling to pen and paper. Washington Post. March 21, 2005: A01.Google Scholar
  25. 25.
    Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. Bmj. 2005;331:1313–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? Jama. 1999;282:867–74.PubMedCrossRefGoogle Scholar
  27. 27.
    Reeves S, Zwarenstein M, Goldman J, et al. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008:CD002213.Google Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Heather C. O’Donnell
    • 1
    • 2
    • 6
    Email author
  • Rainu Kaushal
    • 1
    • 3
  • Yolanda Barrón
    • 1
  • Mark A. Callahan
    • 4
  • Ronald D. Adelman
    • 5
  • Eugenia L. Siegler
    • 5
  1. 1.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of PediatricsColumbia University Medical CenterNew YorkUSA
  3. 3.Department of PediatricsWeill Cornell Medical CollegeNew YorkUSA
  4. 4.FOJP Service CorporationNew YorkUSA
  5. 5.Division of Geriatrics and Gerontology, Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  6. 6.Albert Einstein College of Medicine/Children’s Hospital at MontefioreBronxUSA

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